10.  If no, who do you wish to exercise that control?  _________________________ Relationship:  _________________

11.  If any of your children do not survive you, do you want his or her potential share of your inheritance to pass to his or her children (your grandchildren)?         ____yes ____no

12.  Do any of your children or other beneficiaries have either a physical or mental disability? ____yes ____no

Contingent Beneficiaries: 

13.  If your spouse and children die before you die, or you are unmarried or have no children, or you want your property distributed in a way different from that described above, you may designate other or additional beneficiaries below:  IF YOU NEED MORE ROOM ATTACH AN ADDITIONAL SHEET

FULL NAME                                                                             Relationship  City & State                        Distribution

   First                     Middle                   Last                                                                              All or share (%)

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

Other Property:

14.  Do you have a farm or family-owned business? ___Y___N

15.  Are you the beneficiary of any Trust? ____  Do you hold any powers of appointment? ____    Not sure? _____

16.  Do you own real estate that will be distributed by this will? ___Y___N

17.  Do you wish to make a specific cash bequest? ___Y___N (If yes, please list:)

Name                                    Relationship                                      City/State                                    Amount

___________________________________________________________________________________________

18.  Executor/Personal Representative:  Whom do you wish to serve as executor of your estate?  Your Executor is the person who will be responsible for gathering and distributing your assets and filing your will in probate after your death.  This person has administrative duties only and must distribute your estate in accordance with your will.  A surviving spouse is not automatically appointed.

Primary: ___________________________________________________________________________________

                                Full Name                                              City/State of Current Residence                        Relationship

Alternate: __________________________________________________________________________________

                                Full Name                                              City/State of Current Residence                        Relationship

19.  Guardian:  Do you wish to appoint a guardian of your minor child(ren) if the other natural parent is not alive or for any reason cannot act as guardian? __Y___N   A guardian must be 18 years of age or older.  This person will have actual physical custody and control of the minor children until they reach age 18.

Primary Guardian: _________________________________________________________________________________

                   Full Name                                           City/State of Current Residence                                        Relationship

Alternate Guardian: ________________________________________________________________________________

                   Full Name                                           City/State of Current Residence                                        Relationship

20.  Trusts: If you have minor children who may receive property under your will, you can set up a trust in your will to place the property under the control of a trustee, for the benefit of your child(ren) until they have reached an age you designate. 

Primary: ________________________________________________________________________________________

                                Full Name                                              City/State of Current Residence                                        Relationship

Alternate: ________________________________________________________________________________________

                                Full Name                                              City/State of Current Residence                                        Relationship

Age when property should be distributed to each child: _____ (At least 18 in most states)

21.  Are you interested in a Living Will or Durable Health Care Power of Attorney (ask your attorney about these)? ______

22. Are you interested in a “springing” Durable General Power of Attorney (one which will survive incapacitation)? ______